There’s no denying that the medication therapy management programs (MTMPs) mandated for Medicare Part D plans have been beneficial for seniors, producing positive results that help seniors live healthier lives. The basic principles of these programs are transferable to commercial populations, providing employers with innovative programs to better manage increasing medical and prescription drug costs.

The statistics continue to alarm. In a 2005 Commonwealth Fund survey of working Americans ages 19 to 64, two thirds missed one or more days of work because of their own health problems or those of a family member.

A well-designed and executed MTMP can help employees achieve the highest quality of life possible and a higher level of productivity by helping ensure that they use their drugs safely and appropriately.

Tracking claims

Leading PBMs are at the forefront of promoting safe drug utilization to prevent adverse drug reactions (ADRs) and reduce health care costs with drug interaction detection programs. These programs track all prescription claims for a member from any pharmacy and any doctor in real time, and specifically target members who fill a drug that interacts with a previously filled medication prescribed by a different doctor.

Other examples of MTMP that have evolved from the senior marketplace include:

Polypharmacy programs: These programs are member- and provider-based interventions designed to promote safe and appropriate medication use. The two-phase effort first notifies providers of members with polypharmacy cases. The second phase is a direct-to-members outreach to those who continue to have polypharmacy issues after the provider mailings.

ACEI/ARB initiatives in disease management: These programs are designed to optimize the use of ACEI/ARB therapy in patients with DM and HTN and/or nephropathy by targeting providers of members with the above disease states and no fill history for ACEI/ARB therapy.

Refill-reminder programs: Refill reminder programs offer member-based interventions that target MTMP enrollees who have been identified as non-adherent with select oral maintenance medications. The objectives of the programs are to promote patient awareness of the importance of medication adherence, improve adherence of commonly prescribed maintenance medications, and reduce the number of missed or delinquent fills of maintenance medications.

Employers have recognized that their employees’ health plays a direct role in their day-to-day productivity. More and more, they are looking to their PBMs for innovative programs that will manage their increasing medical and prescription drug costs. MTMPs have proven track records and have been shown to benefit employees of all ages. By helping employees manage their illnesses through such programs, employers help employees improve the quality of their lives, improve productivity in the workplace, and reduce health care costs by avoiding unnecessary hospitalizations and ER visits.

Brian K. Solow, MD, is vice president and senior medical director for clinical services at Prescription Solutions, a UnitedHealth Group company and a PBM that manages the drug benefit of commercial, Medicare, and governmental health plans, as well as employers, union trusts, and third-party administrators.

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